For patients with intractable epilepsy or complex brain tumors, surgery can reduce symptoms and improve quality of life. However, traditional open craniotomy, in which part of the skull is removed, is not always a safe option for patients with deep-seated tumors or those with advanced disease. It also may carry an increased risk of side effects.

But a minimally invasive option, laser interstitial thermal therapy (LITT), provides patients an alternative. LITT offers effective, and in some cases curative, results – with significantly shorter recovery and a lower risk of complications and side effects than with open craniotomies.

UT Southwestern’s Peter O’Donnell Jr. Brain Institute is the most experienced center in North Texas providing LITT. Our program uses state-of-the-art intraoperative magnetic resonance imaging (iMRI), an integrated operating suite that allows us to precisely eliminate or minimise brain lesions once considered inoperable.

The benefits of minimally invasive procedures such as LITT are clear. Patients find relief from their symptoms within days or weeks, with little to no pain and two-thirds less downtime compared with a craniotomy.

UTSW neurosurgeons recently celebrated our 100th LITT procedure performed at William P. Clements Jr. University Hospital, building on our extensive experience in offering this unparalleled level of treatment to more than 200 patients in North Texas during the past decade.

LITT is not only a symbol of hope for patients who once had no options. It is also a life-changing procedure that can give patients with intractable epilepsy or complex brain tumors more control over their lives and more time to do what matters most to them.

How LITT works and why we use it

After making an approximate 4-millimeter (1/8 of an inch) opening in the skull, we attach the guide tube for the laser fiber to the patient’s skull. We then use iMRI guidance to pinpoint the area of the brain affected by epilepsy or a brain tumor. Through the bone opening, we insert a laser fiber directly into the target area.

The fiber transmits pulses of laser energy that release heat (ablation) to dissolve problematic tissue without damaging healthy brain tissue. The iMRI technology allows us to observe the impact of the ablation every nine seconds, in near real time, so that we can adjust the laser to precisely match the shape of the lesion that we are treating.

The procedure, done under general anesthesia, is sometimes as short as two hours. Recovery is swift, and patients are up and moving within hours after surgery. Most patients stay in the hospital just one night after LITT and then go home with a few self-dissolving stitches and little or no pain. On average, patients can expect to be back to a normal routine in about a week – a third of the time compared with an open craniotomy.

Because LITT is a minimally invasive procedure, the risk of complications is lower compared with a traditional craniotomy:

• Shorter hospital stays
• Shorter recovery time
• Less medication
• Less risk of infection
• Fewer hospital readmissions

UTSW neurosurgeons perform LITT with iMRI procedures weekly – a high volume due to the expertise of the specialists on our care team. Although the technology is only approved to treat select conditions, we expect ongoing research to show LITT efficacy for more patient needs in the near future.

Related reading: Epilepsy surgery advancements can eliminate seizures, improve patients’ memories

Who is a candidate for LITT with iMRI?

Patients with epilepsy

LITT with iMRI is becoming a standard of care for intractable epilepsy, which doesn’t respond to medications. Patients living with mesial temporal lobe epilepsy are among those who benefit most. With this condition, seizures originate in the hippocampus, an area deep in the brain that controls speech, learning, and memory. LITT is the least invasive way to remove lesions from the hippocampus, which is difficult to access through traditional surgery.

That was the case for Tyler Wilkins, who had frequent epileptic seizures for several years that no medication combination could effectively treat.

Mr. Wilkins had his LITT procedure April 7, 2023. Before that, his care team at the O’Donnell Brain Institute’s Epilepsy Monitoring Unit used a neuro-imaging system called stereo EEG to pinpoint the epicenter of the seizure activity in his brain. Given the choice between traditional surgery or laser ablation, Mr. Wilkins chose LITT.

“LITT was the less invasive option and it has a quicker healing time, which I found really appealing,” Mr. Wilkins said. “I was released from the hospital the day after the surgery, and I had no restrictions. Within a week, I felt fine with no issues.”

Mr. Wilkins received medication to help reduce brain swelling during the week after his procedure. He attended regular follow-up appointments with our team and has since been released from routine visits unless new concerns arise.

“Ever since my laser surgery, I have felt great. I can drive myself again and I have even been able to start working at a part-time job,” said Mr. Wilkins, who is 25 and lives in Watauga, a suburb of Fort Worth.

Other people with drug-resistant epilepsy who have had the LITT procedure have experienced similar life-changing outcomes. When asked to evaluate their quality of life before and after surgery, patients report significantly less worry about future seizures and a marked improvement in social functioning.

“Ever since my laser surgery, I have felt great. I can drive myself again and I have even been able to start working at a part-time job."

Tyler Wilkins, epilepsy patient of Bradley Lega, M.D.

Patients with brain tumors

LITT has been used for many years to treat brain metastases that are growing, despite previous treatment with radiation therapy. Many of these growing lesions are the result of radiation necrosis, in which healthy brain tissue is dying as a consequence of the prior radiation treatments. Laser surgery allows us to halt this process and restore brain health.

LITT is also an option for some patients with glioblastoma, an aggressive brain tumor that grows quickly and invades the brain through fingerlike tentacles. It is a fatal condition with an average life expectancy of 12-18 months. The use of LITT, in combination with immunotherapy, is an active area of research in patients with glioblastoma.

Related reading: Brain tumor surgery with quadruplets on the way: Katie’s extra-complex pregnancy

The future of minimally invasive treatment for brain conditions

In addition to patient care, UTSW neurosurgeons are at the forefront of highly encouraging research developments. We collaborate with colleagues across the country through the Epilepsy Study Consortium. This group accelerates development of new therapies by working to optimise clinical trial processes and build industry partnerships.

One of our most recent clinical studies is LAANTERN, a national research project that compiled anonymised data from more than 1,000 patients who had LITT procedures. The data provided further insight into the safety and efficacy of laser ablation, as well as the outlook for our patients living with drug-resistant epilepsy and glioblastoma.

We dug deeper into that data to study the outcomes of LITT in patients with meningioma, another type of brain tumor that is usually benign. A recent study summarises our findings showing LITT to be a safe and feasible option for controlling meningiomas, especially for patients with limited treatment options.

Our team at the Harold C. Simmons Comprehensive Cancer Center is also involved in two ongoing clinical trials investigating the use of specially designed nanoparticles that pass the blood-brain barrier and deliver medications to inoperable brain tumors.

Another recent advancement is personalized ultrafractionated stereotactic adaptive radiation therapy (PULSAR). This emerging technology delivers cancer-killing radiation in high-dose pulses at extended intervals. Oncologists can adapt treatment more precisely while integrating other therapies. A promising innovation we are researching is combining PULSAR with targeted chemotherapy drugs that activate inside the central nervous system. Initial data show this combination can be effective in controlling larger brain metastases with limited side effects.

Hope is no longer out of reach for patients with intractable epilepsy or complex brain tumors. Continual research and collaboration with patients are key to bringing world-class, life-changing brain procedures to North Texas.

--Bradley Lega, M.D., and Toral Patel, M.D., Neurological Surgery at UT Southwestern patients with intractable epilepsy or complex brain tumors, surgery can reduce symptoms and improve quality of life. However, traditional open craniotomy, in which part of the skull is removed, is not always a safe option for patients with deep-seated tumors or those with advanced disease. It also may carry an increased risk of side effects. But a minimally invasive option, laser interstitial thermal therapy (LITT), provides patients an alternative. LITT offers effective, and in some cases curative, results – with significantly shorter recovery and a lower risk of complications and side effects than with open craniotomies.UT Southwestern’s Peter O’Donnell Jr. Brain Institute is the most experienced center in North Texas providing LITT.

Our program uses state-of-the-art intraoperative magnetic resonance imaging (iMRI), an integrated operating suite that allows us to precisely eliminate or minimise brain lesions once considered inoperable. The benefits of minimally invasive procedures such as LITT are clear. Patients find relief from their symptoms within days or weeks, with little to no pain and two-thirds less downtime compared with a craniotomy.UTSW neurosurgeons recently celebrated our 100th LITT procedure performed at William P. Clements Jr. University Hospital, building on our extensive experience in offering this unparalleled level of treatment to more than 200 patients in North Texas during the past decade.LITT is not only a symbol of hope for patients who once had no options.

It is also a life-changing procedure that can give patients with intractable epilepsy or complex brain tumors more control over their lives and more time to do what matters most to them. How LITT works and why we use it. After making an approximate 4-millimeter (1/8 of an inch) opening in the skull, we attach the guide tube for the laser fiber to the patient’s skull. We then use iMRI guidance to pinpoint the area of the brain affected by epilepsy or a brain tumor. Through the bone opening, we insert a laser fiber directly into the target area.

The fiber transmits pulses of laser energy that release heat (ablation) to dissolve problematic tissue without damaging healthy brain tissue. The iMRI technology allows us to observe the impact of the ablation every nine seconds, in near real time, so that we can adjust the laser to precisely match the shape of the lesion that we are treating.

The procedure, done under general anesthesia, is sometimes as short as two hours. Recovery is swift, and patients are up and moving within hours after surgery. Most patients stay in the hospital just one night after LITT and then go home with a few self-dissolving stitches and little or no pain. On average, patients can expect to be back to a normal routine in about a week – a third of the time compared with an open craniotomy.

Because LITT is a minimally invasive procedure, the risk of complications is lower compared with a traditional craniotomy:Shorter hospital staysShorter recovery timeLess medicationLess risk of infectionFewer hospital readmissionsUTSW neurosurgeons perform LITT with iMRI procedures weekly – a high volume due to the expertise of the specialists on our care team. Although the technology is only approved to treat select conditions, we expect ongoing research to show LITT efficacy for more patient needs in the near future.Related reading: Epilepsy surgery advancements can eliminate seizures, improve patients’ memoriesWho is a candidate for LITT with iMRI?Patients with epilepsyLITT with iMRI is becoming a standard of care for intractable epilepsy, which doesn’t respond to medications.

Patients living with mesial temporal lobe epilepsy are among those who benefit most. With this condition, seizures originate in the hippocampus, an area deep in the brain that controls speech, learning, and memory. LITT is the least invasive way to remove lesions from the hippocampus, which is difficult to access through traditional surgery.That was the case for Tyler Wilkins, who had frequent epileptic seizures for several years that no medication combination could effectively treat.Mr. Wilkins had his LITT procedure April 7, 2023. Before that, his care team at the O’Donnell Brain Institute’s Epilepsy Monitoring Unit used a neuro-imaging system called stereo EEG to pinpoint the epicenter of the seizure activity in his brain. Given the choice between traditional surgery or laser ablation, Mr. Wilkins chose LITT.“LITT was the less invasive option and it has a quicker healing time, which I found really appealing,” Mr. Wilkins said.

“I was released from the hospital the day after the surgery, and I had no restrictions. Within a week, I felt fine with no issues.”Mr. Wilkins received medication to help reduce brain swelling during the week after his procedure. He attended regular follow-up appointments with our team and has since been released from routine visits unless new concerns arise.“Ever since my laser surgery, I have felt great. I can drive myself again and I have even been able to start working at a part-time job,” said Mr. Wilkins, who is 25 and lives in Watauga, a suburb of Fort Worth.Other people with drug-resistant epilepsy who have had the LITT procedure have experienced similar life-changing outcomes.

When asked to evaluate their quality of life before and after surgery, patients report significantly less worry about future seizures and a marked improvement in social functioning.“Ever since my laser surgery, I have felt great. I can drive myself again and I have even been able to start working at a part-time job."Tyler Wilkins, epilepsy patient of Bradley Lega, M.D.Patients with brain tumorsLITT has been used for many years to treat brain metastases that are growing, despite previous treatment with radiation therapy. Many of these growing lesions are the result of radiation necrosis, in which healthy brain tissue is dying as a consequence of the prior radiation treatments. Laser surgery allows us to halt this process and restore brain health.LITT is also an option for some patients with glioblastoma, an aggressive brain tumor that grows quickly and invades the brain through fingerlike tentacles. It is a fatal condition with an average life expectancy of 12-18 months.

The use of LITT, in combination with immunotherapy, is an active area of research in patients with glioblastoma. Related reading: Brain tumor surgery with quadruplets on the way: Katie’s extra-complex pregnancy.The future of minimally invasive treatment for brain conditions. In addition to patient care, UTSW neurosurgeons are at the forefront of highly encouraging research developments. We collaborate with colleagues across the country through the Epilepsy Study Consortium. This group accelerates development of new therapies by working to optimise clinical trial processes and build industry partnerships. One of our most recent clinical studies is LAANTERN, a national research project that compiled anonymised data from more than 1,000 patients who had LITT procedures. The data provided further insight into the safety and efficacy of laser ablation, as well as the outlook for our patients living with drug-resistant epilepsy and glioblastoma. We dug deeper into that data to study the outcomes of LITT in patients with meningioma, another type of brain tumor that is usually benign. A recent study summarises our findings showing LITT to be a safe and feasible option for controlling meningiomas, especially for patients with limited treatment options. Our team at the Harold C. Simmons Comprehensive Cancer Center is also involved in two ongoing clinical trials investigating the use of specially designed nanoparticles that pass the blood-brain barrier and deliver medications to inoperable brain tumors.

Another recent advancement is personalised ultrafractionated stereotactic adaptive radiation therapy (PULSAR). This emerging technology delivers cancer-killing radiation in high-dose pulses at extended intervals. Oncologists can adapt treatment more precisely while integrating other therapies. A promising innovation we are researching is combining PULSAR with targeted chemotherapy drugs that activate inside the central nervous system. Initial data show this combination can be effective in controlling larger brain metastases with limited side effects.

Hope is no longer out of reach for patients with intractable epilepsy or complex brain tumors. Continual research and collaboration with patients are key to bringing world-class, life-changing brain procedures to North Texas.